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Home My WebLink AboutSWG2023-00229 - SWG As-Built - 8/11/2023 M c Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00' Parcel # 2Z01 K- 5 I - e(a 1 IZ Applicant Name Robert- Reed Subdivision (Name/Div/Block/Lot) Applicant Address 5j 115 N, y$th -. 13 09Mo 1<t( A LOt :112, si3 Of 10t I l I City, State, Zip TaCOYYVt,,VdA a/401* Installer Name Maw( EXCAva-hr1 J Site Address 50 E• Stn&lait(IPI. Shei to Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair [Other Li f}- S+afi on System Type J Pretreatment Type >5 ft.from foundation? - - ❑ N/A ❑ YES ❑ NO >50 ft.from wells? - •- :I ❑ ❑ >50 ft.from surface water? - -— `'f-8 - it ❑ ❑ HCleanout between building and tank? - - - -- - III ❑ ❑ ✓ Tank baffles present? - - -JUL_It 2a23- rII ❑ ❑ d24"access risers over each compartment?- - � ❑ ❑ W Effluent filter installed?- By- •- M ❑ ❑ cn r ISeptic tank capacity (working) gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ OOZ Check valves installed? - - ❑ ❑ ❑ 0Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) E 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? - - ❑ N/A ❑ YES ❑ NO O >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft.from surface water? - - ❑ ❑ ❑ LT: >10 ft. from potable water lines?- - ❑ ❑ ❑ Q Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ re > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ • Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A d YES ❑ NO Y Pump tank capacity(flood) gal Manufacturer ZoeeI i eX Q 24" access riser(s) and accessible from surface?- - ❑ [� ❑ H a Alarm or Control Panel Installed? - - ❑ [i ❑ 2 Control Panel equipped with Timer/ETM /Counter- - 2/ ❑ ❑ M CI. Pump installed in ❑ Bucket or Ef On Block or ❑ Other �( a• Pump Make/Model loeI101( BN2.1o4 ["1 Floats or ❑ Transducer CL a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8'21/2018 ilrr Mason County OSS Installation Report pg. 2 Parcel # ??OI g' 51— 0011 a ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES YNO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES Et/NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain, Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfietd,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create H additional delays in final installation approval and related permits. PPRo . • T _ AUG > MASON COiJNTy ENVIRO 2023 NMENTAL HEAL Jaw [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped "APPROVED"by Mason dance with the septic design stamped "APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. ignature of Installer Date Shane, 1�(adpl� Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public He. •. g--1l � Sig .t : Envfronmen al ealfh Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8;21/2018 RECORD DRAWING (continued) • .01/4 W O NCV 7t • • 0 I.-. m • 6, $ . -16 7, seo ,Cis Sinclair PI� - •. — — — - - m 00 PPROVE , AUG 1 1 2023 MASON COUNTY ENVIRONMENTAL HEALTH JBW